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PHARM 2 SUMMER > NSAIDS and non narctoics > Flashcards

NSAIDS and non narctoics Flashcards

1
Q

3 functions of Anti- Inflamatories NSAIDs

A

1) analgesic
2) anti-inflamatory
3) Antipyretic

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2
Q

Pharmacokinetics of NSAIDs, where are they metabolized, how are they excreted

A
  • food doesn’t change availability
  • get in synoviral fluid good for arthritis
  • metabolized by liver
  • excreted renaly
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3
Q

MOA of NSAIDS

A

they inhibit the cyclooxygenase enzyme (COX).

COX needed to make prostaglandins (PG)

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4
Q

What does COX make and why is this product needed?

A

1) makes PG- needed for maintinance of body

PG protect mucosal layer of stomach, regulate blood flow to the kidney & allow platelets to function

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5
Q

What activates COX 2?

A

-inflamtion

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6
Q

Do COX 2 inhibitors specificly only inhibit COX 2

A

no only a little more

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7
Q

What is the only COX 2 inhibitor ?

A

Celebrex

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8
Q

Most ADRs of NSAIDs are related to inhibiting which cox?

A

Cox 1

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9
Q

GI side effects of NSAID

A

1) increased gastric acid bc PGs is GI mucosa protective
2) Dyspepsia
3) Gastro Duodenal Ulcer

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10
Q

During what time period of treatment dose hepatotoxicity from NSAIDs occur?

A

first 6 weeks

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11
Q

What to monitor and how often when pt. is on NSAIDs

A

-serum transaminases measured every 2 weeks for long term treatment

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12
Q

Black Box warning on NSAIDs is for what?

A
  • cardiovascular thrombotic events
  • myocardial infarctions
  • stroke
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13
Q

What do NSAIds cause you retain?

A

salt and fluid

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14
Q

How many points do NSAIDs raise ur BP?

A

8-10 pts

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15
Q

Angioedema

A

an unstable complement system which is activated by inhibition of prostaglandins

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16
Q

who do you avoid using NSAIDs in?

A

asthmatic pts w/ polyps

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17
Q

ASA Aspirin

A

-irreversibly inhibits COX enzymes, platelet effect last 10 days

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18
Q

nonacetylated salicylates

A

dont have any effect on platelets

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19
Q

Do NSAIDs increase or decrease serum creatinine?

A

increase bc decrease blood flow to kidney

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20
Q

when is there an absolute contraindication to NSAIDs?

A

Abnormal kidney function

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21
Q

CNS effects of NSAIDs

A

HA

aseptic meningitis

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22
Q

which NSAIDs are the ones known for causing HAs?

A
  • indomethacin

- tolmetin

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23
Q

which NSAIDs are the ones known for causing aseptic meningitis?

A

ibprofin

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24
Q

Which drugs to NSAIDs decrease the effectivness of?

A

Diuretics
ACEI
ARBS
- can lead to hyperkalemia

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25
PUD with SSRI and NSAIDs?
SSRI may lead to depletion of serotonin in platelets, which is thought to play an important role in hemostasis
26
Which drugs increase PUD bleeding with NSAIDs
clopidogrel warfarin hepatins DONT DO IT
27
Aspirin and Nonacetylated Salicylates
``` Acetyl salicylic acid Magnesium & choline salicylate ( Trilisate) Magnesium salicylate ( Doan’s Pills) Choline salicylate (Arthropan) Sodium salicylate Salicylsalicylate (Disalcid) ```
28
ASA
- rapidly absorbed | - 0 order
29
ASA dosage for mild pain
325-600
30
ASA dose for arthritis
650
31
ASA dosage for antiplatelet effect, angina, MI, CABG
81
32
How much blood loss in lost every day if ASA routinely used?
teaspoon in stool
33
Hyperpnea with ASA
high respiratory rate -> resp. aslk | antidote: stomach irrigation, IV fluids, sodium bicarb
34
Nonacetylated salicylates
less effective than ASA | dont use for antiplatelet effect
35
COX 2 selective NSAIDS
Celecoxib (Celebrex) | Meloxicam (Mobic)
36
COX 2 selectives
- the idea there would be more anti-inflammatory effect and less effect on stomach - more CVS events (MI, stroke). This is because they inhibit COX-2 mediated prostacyclin synthesis in vascular endothelium not protective of kidney blood flow but seem to cause fewer GI problems & less bleeding
37
What theraputic effect do COX 2s have?
1) antipyretic 2) antiinflamatory 3) analgesic
38
Celecoxib (CELEBREX)
- Sulfa: can get a rash if allergic to sulfa - Long-term use of celecoxib may cause an increased risk of serious adverse cardiovascular thrombotic events, MI, and stroke, which can be fatal.
39
3 main Nonselective NSAIDs and their dosages
- Diclofenac (Voltaren)- 50 mg and 75 mg twice a day - Ibuprofen (Motrin, Advil) 800 3 day - Naproxen (Naprosyn, Aleve) 550 twice a day
40
IM NSAID is called...
Ketorolac
41
Ketorolac-
- IM loading dose, then oral max 40 mg/day - use 5 days or less - dont use for inflamation
42
3 NSAIDs with long 1/2 life -- ONCE DAILY DOSING
Oxaprozin (Daypro) Piroxicam (Feldene) Nabumetone (Relafen)
43
tolmentin
not effective for gout
44
how long do you give an NSAID before you switch?
2 weeks
45
cases where you should avoid using NSAIDs
have CHF, renal failure, active peptic ulcer disease, uncontrolled HTN
46
Is it okay to combine 2 NSAIDs?
NO
47
NSAID in pts with hx of high BP
check BP before starting and every two weeks | if high stop or give more HTN meds
48
What do you use if PUD and over 70?
Celebrex w/ PPI, and Misoprostol
49
Aceominphen APAP
-oral or rectal -onset in 30-60 min less than 3 grams/day metabolized by liver and is toxic
50
APAP annecdote
mucomyst
51
What are the theraputic properties of APA?
-analgesic and antipyretic | NOT ANTI INFLAMTORy
52
Adverse effects of APAP
dizziness, excitment, disorientation
53
APAP antidote is...
N-acetylcysteine
54
can you add APAP to NSAIDs?
yes
55
Neuropathic Pain Relievers
Gabapentin (Neurontin) Pregabalin (Lyrica) amitryptyline- migraine and diabetic neuropathy
56
Two topical Pain Relievers
- Methyl slicylate (wintergreen oil) - Capsacin lidocainpatch patch lidocaine/Prilocaine EMLA cream
57
MOA capsacin
release substance P, continuously stimulates nerve (hurts at first), continuous nervestimulation deplets substance P, works best for neuropathic pain
58
lidocaine patch
you can cut it
59
mild pain
acetominophin
60
moderate pain
NSAID
61
visceral pain?
narcotics, start with schedule 4- tramadol

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